Scarring Alopecia: How Scarring Can Cause You to Lose Hair

Most hair loss, whether temporary hair shedding or permanent hair loss that’s caused by male pattern baldness, occurs with no scarring. 

Scarring alopecia, or cicatricial alopecia, is an uncommon type of hair loss that’s accompanied by scarring. Instead of simply damaging the hair follicles, scarring alopecia involves completely destroying the hair follicles and replacing them with areas of scar tissue.

There are several different disorders that can cause scarring alopecia, from ones that are targeted specifically towards the hair follicles to systemic diseases that damage the scalp and hair follicles as part of a wider range of symptoms. 

Below, we’ve explained what scarring alopecia is in more detail. We’ve also listed some of the most common causes of scarring alopecia in men and women, as well as what you can do to treat hair loss that’s accompanied by scarring.

What is Scarring Alopecia?

Scarring alopecia is a form of hair loss that involves the destruction of certain hair follicles and the development of scar tissue. This type of hair loss is often referred to as “cicatricial alopecia” in medical literature. 

There are several different reasons why scarring alopecia can occur. It often occurs as a result of a range of health conditions that affect the hair follicles. It can also occur due to an injury that results in the development of scar tissue in the scalp. 

Primary scarring alopecia occurs when the hair follicles are specifically targeted by a disease or condition. Causes of primary scarring alopecia include dissecting cellulitis, folliculitis decalvans, follicular degeneration syndrome and lichen planopilaris.

Many of these conditions are hair-specific versions of common skin conditions that can affect a range of areas of the body. 

Secondary scarring alopecia occurs when an exogenous factor, such as a burn or scarring from another injury, affects the hair follicles. This type of scarring alopecia can also occur as a result of autoimmune conditions such as lupus and scleroderma. 

Unlike androgenic alopecia, or male pattern baldness, which affects men far more often than it affects women, scarring alopecia can affect both sexes. 

Because scarring alopecia is caused by a variety of disorders, the symptoms can differ from one person to another. Some people with scarring alopecia notice slow, gradual hair loss without any discomfort or noticeable symptoms, while others experience rapid, uncomfortable hair loss.

While scarring alopecia involves the formation of scar tissue, most forms don’t result in visible scarring on the scalp itself. Instead, the scarring typically occurs below the surface layer of the skin, where it affects the hair follicles. 

Compared to male pattern baldness, scarring alopecia is not common. However, it’s also not a rare form of hair loss. According to study data, approximately  seven percent of patients who visit specialist hair loss clinics are affected by a form of scarring alopecia. 

Common Signs of Scarring Alopecia

Scarring alopecia can be difficult to detect. Often, the symptoms are identical to those of male pattern baldness, with strands of hair gradually falling out and causing thinning in certain areas of the scalp. 

Many cases of scarring alopecia look almost identical to androgenic hair loss, with no obvious signs of inflammation or damage. 

Others may be accompanied by obvious signs of inflammation and damage to the scalp. This type of scarring alopecia can involve visible scaling, redness and the development of pustules and skin lesions. The pigmentation of the scalp can also be affected. 

These symptoms are often painful, with itching, burning and other forms of discomfort reported by people with scarring alopecia. 

Scarring alopecia often occurs in a unique pattern, causing hair loss in areas of the scalp that aren’t typically affected by male pattern baldness. If you notice your hair starting to fall out in a strange pattern, it’s best to speak to a dermatologist.

Most of the time, scarring alopecia is diagnosed using a scalp biopsy. A surgeon will remove a small sample from the affected area of your scalp, which will then be analysed to determine the cause of the inflammation. 

Depending on your symptoms, your doctor might also recommend a “hair pull test” to see if hair is still actively growing in the affected area. For some cases of scarring alopecia, trichoscopy is used to reach a diagnosis. 

Treatments for Scarring Alopecia

Because scarring alopecia can be caused by a variety of disorders, there’s no one-size-fits-all treatment. Instead, your doctor might prescribe one or several different treatments to prevent further inflammation and damage to your hair follicles. Common treatments include:

  • Anti-inflammatory medications, which can help to control inflammation and prevent further damage to your hair follicles.

  • Corticosteroids, which are used to treat several skin conditions that can contribute to scarring alopecia.

  • Immunosuppressants, which are used to treat forms of scarring alopecia caused by autoimmune conditions.

  • Other medications, such as oral and topical antibiotics, antimicrobials, isotretinoin and numerous other drugs. 

Because scarring alopecia can physically destroy your hair follicles, hair typically will not grow back in areas of your scalp that have been severely affected by scarring. For hair follicles that have not been destroyed by scarring, medications like minoxidil can help to stimulate growth

Hormonal medications for male pattern baldness, such as finasteride, are not designed to treat scarring alopecia and will not prevent damage to your hair from inflammation. 

After the cause of the scarring alopecia has been treated successfully, hair can sometimes be restored to the affected areas of the scalp through hair transplant surgery

In a Nutshell: Scarring Alopecia

Scarring alopecia can affect both men and women. It’s significantly less common than hair loss from male pattern baldness, meaning it’s unlikely to be the cause of your hair loss if your hair is falling out in a normal pattern, such as a receding hairline or thinning around your crown.

However, if you have unusual patches of hair loss, or if you have an autoimmune condition that you know can cause inflammation, it’s worth talking to a dermatologist about the symptoms you are experiencing. 

By acting quickly, you can minimise the total damage to your hair follicles from scarring alopecia and maintain as much of your hair as possible. 

The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of hims, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis or treatment, and should never be relied upon for specific medical advice.